antibiotic in incomplete abortion by liza tarca, md

To Give or Not To GiveThe Use of Antibiotic in Incomplete Abortion

Liza Tarca-Cruz, MD

OB Resident

Journals

• Potential Pathogens in the Lower Genital Tract at Manual Vacuum Aspiration for Incomplete Abortion in Korle Bu Teaching Hospital, Ghanna

A.T Lasser, R.M.K., Adanu, M.J Newman and J.A Opintah

East African Medical Journal Vol. 81, No. 8 August 2004

• The Cochrane Collaboration on Antibiotic for Incomplete Abortion (Review)

May W, Gulmezoglo AM, Ba-Thike K

WHO, The Cochrane Library , 2007, Issue 4

Journals

• Clinical Guidelines: Prevention of Infection After Induced Abortion

Society of Family Planning 20102, October 2010

• SOGC Clinical Practice Guidelines: Antibiotic Prophylaxis in Gynaecologic Procedures

Nancy Van Eyk, MD et al, J Obstetr Gynaecol Can 2012:34(4):382-391

Potential Pathogens in the Lower Genital Tract at Manual Vacuum Aspiration for Incomplete Abortion in Korle Bu Teaching Hospital, Ghanna

The Cochrane Collaboration on Antibiotic for Incomplete Abortion (Review)

Clinical Guidelines: Prevention of Infection After Induced Abortion

• The features of antibiotics appropriate for use as prophylaxis– Low toxicity

– Established safety record

– Not routinely used for treatment of serious infections

– Spectrum of activity includes micro-organisms most likely to cause infections

– Reaches useful concentration in relevant tissues during procedure

– Administered for short duration

– Administered such that it is present at the surgical sites at the start of the procedure


• Does antibiotic prophylaxis lower the risk of infection following surgical abortion?– The risk of infection was lower in the group receiving antibiotics,

though the difference is not statistically significant in the 8 studies done.

– The benefits of antibiotic prophylaxis are less clear in a population at very low risk.


• Which antibiotic is best for prevention of postabortal infection?– Nitromidazoles (metronidazoles and tinidazole)– Tetracyclines (doxycycline)

SOGC Clinical Practice Guidelines: Antibiotic Prophylaxis in Gynaecologic Procedures

• 2 Radomized Placebo Controlled Trials– Assess the effectiveness of prophylactic antibiotics to

reduce infectious morbidity following evacuation of uterus after incomplete abortion

– Prophylactic antibiotics are not suggested to reduce infectious morbidity following surgery for a missed or incomplete abortion. (I-E)

SUMMARY

• Organisms responsible for bacterial vaginosis were the most frequently isolated potential pathogen in the cervical canal of patients with incomplete abortion.

• Management of incomplete abortion of patients should include antibiotic prophylaxis against bacterial vaginosis.

SUMMARY

• No evidence to either recommend or to abandon the use of prophylactic antibiotics in women with an incomplete abortion.

• A single dose may be more suitable.– To minimize risk of adverse reactions &

resistance

SUMMARY

• Antibiotics are generally given when there are signs of infection.

• Prophylaxisis antibiotics are not suggested to reduce infectious morbidity following surgery for a missed or incomplete abortion.– Perioperative oral doxycycline given up to 12hours

before a surgical abortion

SUMMARY

• The best antibiotic for prevention of postabortal infections are nitroimidazoles and tetracyclines.– Doxycycline 200mg preoperatively– Doxycyline 100mg 1 hour before and 200mg

1 ½ hour after – Tetracyclines 500mg QID x 1 week

CONCLUSION

Giving of prophylactic or post operative antibiotic to patient’s who had incomplete abortion and will undergo completion curettage should be individualized.

High risk patients should receive antibiotic while low risk may or may not have treatment.

However, a single dose may be beneficial rather than a complete antibiotic course

antibiotic in incomplete abortion by liza tarca, md

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